Unprovoked Seizure In Childhood Research Articles

Role of EEG and MRI brain in the diagnosis of unprovoked seizures in children in a tertiary care centre

Role of EEG and MRI brain in the diagnosis of unprovoked seizures in children in a tertiary care centre

Characteristics and clinical value of early electroencephalography (EEG) after a first unprovoked seizure in children

ObjectiveThis study aimed to examine the timing and features of electroencephalography (EEG) as a predictor of seizure recurrence in children with a first unprovoked seizure. MethodsWe retrospectively evaluated the medical records and EEG recordings of pediatric patients who presented within 24 h of a first unprovoked seizure between January 2018-December 2019 and had at least 1 year of pediatric neurology clinical follow-up. ResultsThe study included 108 patients (53.7% males) with a mean age of 98.75±57.75 months. Sixty-eight patients (63%) had an abnormal initial EEG, of which 55 (80.9%) were focal. The semiology of the first unprovoked seizure was focal in 50% of the patients and correlated with initial EEG findings (p<0.001). Forty-three patients had seizure recurrence during the follow-up period of mean 26.86±7.39 months. Recurrence was observed in the first 6 months in 30 patients and occurred twice in 4 patients. An abnormal EEG after the first unprovoked seizure was found to be an independent risk factor for recurrence, with a 2.42-fold higher recurrence risk in patients with focal EEG abnormalities compared to those with a normal EEG (p = 0.044). Analysis of 7 different timing patterns up to 96 h after the first unprovoked seizure showed that EEG timing was not associated with abnormality detection. DiscussionOur study showed that EEG abnormalities, especially focal abnormalities, after a first unprovoked seizure are a predictor of seizure recurrence. But the rate of detection of EEG abnormalities was not related to the timing of EEG recording, relative to seizure occurrence.

Predictors of Recurrence after a First Unprovoked Seizure in Childhood: A Prospective Study

The second part of the revised definition of epilepsy by ILAE in 2014 allows a condition to be considered epilepsy after one seizure if there is a high risk of having another seizure; if the risk factor is not precisely be known we have to wait for another seizure. This definition necessitates search for probable risk factors. We aimed this study to assess the recurrence rate and associated risk factors for recurrences after a first unprovoked seizure in children within two years of first attack. This prospective study was conducted on in Banglabandhu Sheikh Mujib Medical University (BSMMU) from June 2016 to December 2018. Among 137 children finally 120 children aged between1 month to 14 years after a first seizure were followed up for 2 years. Diagnosis of seizure was confirmed on the basis of diagnostic criteria and none of the children was treated by any antiepileptic drugs after first episode. Overall recurrence rate within 2 years of follow up was 38%. Majority of recurrence (65%) observed within 6-10 months of initial seizure. Significant risk factors were an abnormal EEG finding (p=&lt;0.001), focal seizure (p=&lt;0.001), seizure at sleep (p=0.001) and initial presentation with status epilepticus (p=0.001). Abnormal neuroimage findings were also associated with seizure recurrence, but it was not statistically significant. Age of the patients and underlying motor and cognitive delay was not a significant risk factor for recurrence. A great percentage of first seizure didn’t show recurrence but there are so many factors can determine the possibilities of recurrence, early identification of risk factors specially the focal pattern of seizure, seizure in sleep, status epilepticus and abnormal electrophysiology are the best predictive factors of recurrence, so identifying the high risk group of recurrence helps to initiate early antiepileptic drug and prevent further recurrence.

Anxiety of families after first unprovoked or first febrile seizure – A prospective, randomized pilot study

ObjectivesParents of children with a first unprovoked seizure report high levels of stress and anxiety. Little is known however about interventions that might help to reduce anxiety. We aimed to evaluate anxiety of parents and children after a first unprovoked seizure and assess the anxiety-reducing effect of a semi-structured follow-up in a first seizure clinic (FSC). In comparison, parents of children with febrile seizures are also evaluated, as an example of anxiety evolution without follow-up intervention after provoked seizures. Study designIn this prospective, interventional study, patients presenting with a first unprovoked seizure were randomized to early care (EC) with follow-up in FSC within 3 weeks and late care (LC), follow-up in FSC after 4 months. Anxiety levels of parents and patients were scored with the State Trait Anxiety Inventory (STAI) after the initial seizure (T0), 3 and 12 months (T1, T2). To assess the effect of the semi-structured follow-up, anxiety scores were compared between the two groups at baseline, at T1 (i.e., after intervention in EC but prior to intervention in LC) and at T2. Parents of children with febrile seizures (FS) were prospectively followed up without intervention. ResultsFifty two patients were included (EC n = 18, LC n = 18, FS n = 15). Initial state anxiety in parents was high in all groups. At T1 (i. e. after intervention in EC but not LC) state anxiety was significantly higher in LC (52.2 (16.7) vs. 33.3 (5.3), p < 0.01). This effect persisted after 12 months, despite intervention in LC in the meantime (39.0 (11.7) vs. 28.8 (6.2); p < 0.01)). The effect in children was similar (T1: 40.6 (8.3) vs. 29.8 (5.1); p < 0.05 and T2: 33.5 (4.7) vs. 24.7 (3.6); p < 0.01). State anxiety in FS decreased within 3 months without intervention (50.0 (14.5) to 33.7 (9.2)). ConclusionsA timely and structured follow-up in a FSC offers effective and sustained reduction of anxiety-levels after first unprovoked seizure in children. In contrast, anxiety after a first febrile seizure decreases over time without additional intervention.

Risk of seizure recurrence after a first unprovoked seizure in childhood

ObjectiveThe aim of this study was to assess the risk of recurrence after a first unprovoked seizure in childhood and to explore the correlation between the first and second seizures in recurrent patients. MethodsIn a prospective study, we included 467 children aged 1 month to 16 years, who were attended to between November 1, 2008 and October 31, 2016 following a first seizure. Children who had been started on treatment with antiepileptic drugs were excluded. Recurrence rates were calculated using Kaplan–Meier survival analyses. Univariate and multivariate analyses for recurrence risk were performed using the Cox proportional hazards model. The kappa coefficient of correlation for categorical data was calculated. ResultsRecurrences occurred in 280 children (60.0%), of which 75 (26.8%) occurred in the first month, 184 (65.7%) within 6 months, and 256 (91.4%) within 2 years. None of the patients had new neurologic sequelae after their first or second seizure. The estimates of seizure recurrence risk were 39.5%, 48.1%, 55.1%, 60.8%, 61.8% and 61.8% at 0.5, 1, 2, 5, 8, and 10 years after the first seizure, respectively. Multivariate analysis showed that abnormal electroencephalogram and neuroimaging findings significantly increased the risk of recurrence. First and second seizures were significantly associated with state of arousal, status epilepticus, and multiple seizures in recurrent patients. ConclusionOver half of untreated children had recurrence after a first unprovoked seizure, but prognosis was good overall.

Scalp Ripples Can Predict Development of Epilepsy After First Unprovoked Seizure in Childhood.

Identification of children at risk of developing epilepsy after a first unprovoked seizure can be challenging. Interictal epileptiform discharges are associated with higher risk but have limited sensitivity and specificity. High frequency oscillations (HFOs) are newer biomarkers for epileptogenesis. We prospectively evaluated the predictive value of HFOs for developing epilepsy in scalp electroencephalogram (EEG) of children after a first unprovoked seizure. After their first seizure, 56 children were followed prospectively over 12 months and then grouped in "epilepsy" or "no epilepsy." Initial EEGs were visually analyzed for spikes, spike ripples, and ripples. Inter-group comparisons of spike-rates and HFO-rates were done by Mann-Whitney U test. Predictive values and optimal thresholds were calculated by receiver operating characteristic (ROC) curves. In the epilepsy group (n = 26, 46%), mean rates of ripples (0.3 vs 0.09 / minute, p < 0.0001) and spike ripples (0.6 vs 0.06 / minute, p < 0.05) were significantly higher, with no difference in spike rates (1.7 vs 3.0 / minute, p = 0.38). Of those 3 markers, ripples showed the best predictive value (area under the curve [AUC]ripples = 0.88). The optimal threshold for ripples was calculated to be ≥ 0.125 / minute with a sensitivity of 87% and specificity of 85%. Ripple rates were negatively correlated to days passing before epilepsy-diagnosis (R = -0.59, p < 0.0001) and time to a second seizure (R = -0.64, 95% confidence interval [CI] = -0.77 to 0.43, p < 0.0001). We could show that in a cohort of children with a first unprovoked seizure, ripples predict the development of epilepsy better than spikes or spike ripples and might be useful biomarkers in the estimation of prognosis and question of treatment. ANN NEUROL 2021;89:134-142.

Antiepileptic Drugs in Children : Current Concept.

An epileptic seizure is defined as the transient occurrence of signs and/or symptoms due to abnormally excessive or synchronous neuronal activity in the brain. The type of seizure is defined by the mode of onset and termination, clinical manifestation, and by the abnormal enhanced synchrony. If seizures recur, that state is defined as epilepsy. Antiepileptic drugs (AEDs) are the mainstay of treatment. Knowledge about initiating and maintaining adequate AEDs is beneficial for the clinician who treats children with epilepsy. This article will delineate the general principles for selecting, introducing, and discontinuing AEDs and outline guidelines for monitoring adverse effects. In general, AED therapy following a first unprovoked seizure in children is not recommended. However, treatment should be considered after a second seizure. In children and adolescents, if they are seizure-free for at least 2 years, attempts to withdraw medication/s should be made, taking into account the risks vs. benefits for the individual patient. The decision on when and what AED to use should be tailored according to the patient. For optimal treatment, the selection of adequate AEDs can be achieved by considering the precise definition of the patient’s seizure and epilepsy syndrome. Continuous monitoring of both therapeutic and adverse effects is critical for successful treatment with AEDs.

Role of neuroimaging and electroencephalogram in first unprovoked seizures in children from Cairo

Background First unprovoked seizure (FUS) and complex febrile seizure (CFS) are common pediatric issues of great debate with respect to the role of electroencephalogram (EEG) and neuroimaging in their diagnosis. Aim To determine the frequency of abnormal EEG and neuroimaging results in children with FUS and CFS and to detect the correlation between EEG and neuroimaging results. Patients and methods A total of 100 children (6 months to 12 years of age), who presented with first afebrile or CFS underwent EEG and neuroimaging (computed tomography and/or MRI). This was a prospective randomized controlled trial. Results A total of 100 cases within the age group 6 months to 12 years were recruited. FUS was seen in 63 cases and CFS in 37 cases. Overall, 69.8% cases of FUS were generalized and 30.2% were focal. The prevalence of EEG abnormality was found in 33% of the whole studied population: 44.4% in patients with FUS and 13.5% in patients with CFS. The prevalence of neuroimaging abnormality was found in 15% of the whole studied population: 20.6% in patients with FUS and 5.4% in patients with CFS. Neuroimaging abnormality was seen more commonly in those patients who had an abnormal EEG, with a statistically significant increase in cases with FUS. Conclusion EEG and neuroimaging abnormalities were more prevalent in children with FUSs than those with CFSs. Abnormal EEG and neuroimaging were more common in children with partial seizures than those with generalized seizures. Neuroimaging was abnormal in a significant number of children having abnormal EEG, so neurologically free patients having normal EEG can be safely discharged without neuroimaging, if follow-up is assured. When EEG is abnormal in FUS, the probability of having abnormal neuroimaging increases as compared with those cases where EEG is normal. In case of generalized seizures, patients with abnormal EEG may have abnormal computed tomography/MRI scans, but there are fewer possibilities of a patient with abnormal EEG to have a normal neuroimaging. In partial seizures, abnormal EEG increases the risk of having abnormal neuroimaging than in generalized seizures, and normal EEG in partial seizures markedly decreases the risk of having an abnormal neuroimaging generalized seizures. CFSs in otherwise neurologically free children rarely indicate the presence of lesion on neuroimaging even if associated with EEG abnormalities. Neuroimaging abnormalities in neurologically free children with FUS and CFSs do not require urgent intervention.

First‐ever convulsive seizures in children presenting to the emergency department: risk factors for seizure recurrence and diagnosis of epilepsy

Aetiologies of first-ever convulsive seizures may be diverse, not all leading to recurrence or epilepsy diagnosis. We aimed to describe the epidemiology of first-ever convulsive seizures in children, investigating risk factors for recurrence and epilepsy diagnosis. This was a retrospective study of children presenting with a first-ever convulsive seizure to a tertiary-care paediatric emergency department (PED) in Italy, in a 12-month period (2011-2012). One hundred and eight children (57 males, 51 females) presented to the PED for a first-ever convulsive seizure; 90.7% were 6months to 6years old (median age 1y 10mo, mean 2y 7mo, range 0mo-14y 4mo). Seizure duration was less than 5minutes in 76.8%. Seizures were 'unprovoked' in 19.4% and 'provoked' in 80.6%. At 4-year follow-up, 37.9% of patients experienced recurrence and 13.6% received a diagnosis of epilepsy. Factors significantly associated with recurrence were the 'unprovoked' nature of the first seizure, multiple seizures in the first 24hours, positive family history of febrile seizures or epilepsy, and pre-existing neurological conditions/problems. Factors significantly associated with a diagnosis of epilepsy were the 'unprovoked' nature of the first seizure, age older than 6years, pre-existing neurological conditions/problems, and focal onset of first seizure. Children presenting to the PED with first-ever convulsive seizures represent a heterogeneous group. The identification of prognostic factors for recurrence and epilepsy diagnosis may help provide tailored counselling and follow-up. Seizures were 'unprovoked' in 19.4% and 'provoked' in 80.6% of children presenting to the emergency department. At 4-year follow-up, 37.9% relapsed, and 13.6% received a diagnosis of epilepsy. 'Unprovoked' first seizure, family history of febrile seizures, and pre-existing neurological conditions were associated with recurrence. 'Unprovoked' first seizure, age younger than 6years, and pre-existing neurological conditions were associated with epilepsy diagnosis.

Camphor induced status epilepticus: a case report

Camphor is very toxic compound, which can be fatal for infants and children even if ingested in very small doses. Around 3-5 ml of 20% camphor oil or &gt;30mg/Kg is a potentially lethal dose. Camphor is used very frequently for house hold purposes. The chances of accidental ingestion by children are high particularly in toddlers. Here author report 2 years old previously well child brought with status epilepticus with no apparent trigger. Child required benzodiazipine, phenytoin and levetiracetam loading for seizure control and was ventilated. Complete evaluation for seizure cause was planned post stabilization, but during intubation camphor odour was noticed and parents accepted a possibility of camphor ingestion. Hence seizure was attributed to camphor toxicity. Further evaluation was withheld. Child had no seizure recurrence and AED was stopped prior to discharge after documenting normal neurological examination and EEG. This case highlights the need for considering camphor poisoning as a cause of status epilepticus in the toddler age group and importance of proper enquiry about possible exposure and complete examination including odour in all cases of unprovoked seizures in children which can help us avoid unnecessary investigations searching for the cause of status epilepticus.

Neurodevelopmental comorbidities and seizure control 24 months after a first unprovoked seizure in children

PurposeTo follow children with newly diagnosed unprovoked seizures to determine (1) whether the prevalence of neurodevelopmental comorbidities and cerebral palsy (CP) changed after the initial seizure, and (2) the association between studied comorbidities and seizures 13–24 months after seizure onset or initiation of treatment. MethodsAnalyses were based on 750 children (28 days–18 years) with a first unprovoked seizure (index) included in a population-based Incidence Registry in Stockholm between 2001 and 2006. The children were followed for two years and their medical records were examined for a priori defined neurodevelopmental/psychiatric comorbidities and CP and seizure frequency. Baseline information was collected from medical records from before, and up to six months after, the index seizure. Odds ratios (OR) of repeated seizures 13–24 months after the first seizure or after initiation of anti-epileptic drug treatment was calculated by logistic regression and adjusted for age and sex. ResultsAt baseline, 32% of the children had neurodevelopmental/psychiatric comorbidities or CP compared to 35%, 24 months later. Children with such comorbidities more often experienced seizures 13–24 months after the index seizure (OR 2.87, CI 2.07–3.99) with the highest OR in those with CP or attention deficit hyperactivity disorder (ADHD). Children diagnosed at age <1 year exhibited the highest prevalence of comorbidities as well as OR for repeated seizures. A combination of young age and comorbidity was associated with an OR for repeated seizures of 5.12 (CI 3.03–8.65). Among the children without comorbidities 76% were seizure free 13–24 months after the index seizure or after initiation of AED treatment compared to 53% of children with comorbidities. ConclusionsThis study indicates that neurodevelopmental comorbidities and CP in children with epilepsy tend to be present already at seizure onset and that such comorbidities are strong indicators of poor outcome regarding seizure control with or without treatment.

What Happens Next? Recurrence Rates for First Unprovoked Seizures in Children.

What Happens Next? Recurrence Rates for First Unprovoked Seizures in Children.

Early Recurrence of First Unprovoked Seizures in Children

The risk of early seizure recurrences after first unprovoked seizures in children is largely unknown. We aimed to determine the rate of seizure recurrence within 14 days of first unprovoked seizures in children and identify associated risk factors. Secondarily, we aimed to determine the risk of recurrence at 48 hours and 4 months. We conducted a secondary analysis of a multicenter cohort study of children 29 days to 18 years with first unprovoked seizures. Emergency department (ED) clinicians completed standardized histories and physical examinations. The primary outcome, recurrent seizure at 14days, and the secondary outcomes, recurrence at 48 hours and 4 months, were assessed by telephone follow-up and medical record review. For each recurrence time point, we excluded those patients for whom no seizure had recurred but chronic antiepileptic drugs had been initiated. A total of 475 patients were enrolled in the parent study. Of evaluable patients for this secondary analysis, 26 of 392 (6.6%, 95% confidence interval [CI]= 4.4%-9.6%) had recurrences within 48 hours of the incident seizures, 58 of 366 (15.8%, 95% CI= 12.3%-20.0%) had recurrences within 14 days, and 107 of 340 (31.5%, 95% CI= 26.6%-36.7%) had recurrences within 4 months. On logistic regression analysis, age younger than 3 years was independently associated with a higher risk of 14-day recurrence (adjusted odds ratio [OR]= 2.1, 95% CI= 1.2-3.7; p=0.01). Having had more than one seizure within the 24 hours prior to ED presentation was independently associated with a higher risk of seizure recurrence at 48hours (adjusted OR= 4.3, 95% CI= 1.9-9.8; p<0.001). Risk of seizure recurrence 14 days after first unprovoked seizures in children is substantial, with younger children at higher risk. Prompt completion of an electroencephalogram and evaluation by a neurologist is appropriate for these children.

Role of neuroimaging in children with first unprovoked seizure: A prospective observational study

Objective: Seizure is a common neurologic problem that occurs in 3–5% of children. Seizure may be provoked caused by a brain insult, metabolic or toxic disturbance of brain function or unprovoked. Based on several studies, the prevalence of abnormal neuroimaging in pediatric patients with a new onset afebrile seizure is estimated to be 0 % to 21%. As pointed out by previous reports aetiology and incidence of unprovoked seizures is expected to be different in developing countries like India with a high incidence of infective causes. So, this study was done to find out the proportion of cases with neuroimaging abnormality and the etiology of first unprovoked seizure in children in an Indian setup. Methods: This prospective observational study was conducted at a tertiary care teaching hospital of Northern India. Total 115 cases of 6 months to 14 years of age were enrolled over one year from September 2015 to August 2016 after obtaining written informed consent. Data collection was done on a predesigned case record form. Every enrolled child was subjected to neuroimaging either CT scan head or brain MRI. Results: Out of 115 cases 40(34.8%) had abnormal neuroimaging of which 28(70%) had inflammatory granuloma. Inflammatory granulomas all except one were due to active/calcified focus of neurocysticercosis. Proportion of children having inflammatory granuloma was significantly high in children above 2 years of age in comparison to children below 2 years of age (p=0.003) and in children with focal seizure in comparison to children with generalised tonic clonic seizure(p=0.024). Conclusion: Prevalence of neuroimaging abnormality in children presenting with first unprovoked seizure is high in India due to high prevalence of neurocysticercosis and tuberculosis. So, neuroimaging should be considered in all children with first unprovoked seizure.

Diagnostic and Therapeutic Management of a First Unprovoked Seizure in Children and Adolescents With a Focus on the Revised Diagnostic Criteria for Epilepsy.

By definition, unprovoked seizures are not precipitated by an identifiable factor, such as fever or trauma. A thorough history and physical examination are essential to caring for pediatric patients with a potential first unprovoked seizure. Differential diagnosis, EEG, neuroimaging, laboratory tests, and initiation of treatment will be reviewed. Treatment is typically initiated after 2 unprovoked seizures, or after 1 seizure in select patients with distinct epilepsy syndromes. Recent expansion of the definition of epilepsy by the ILAE allows for the diagnosis of epilepsy to be made after the first seizure if the clinical presentation and supporting diagnostic studies suggest a greater than 60% chance of a second seizure. This review summarizes the current literature on the diagnostic and therapeutic management of first unprovoked seizure in children and adolescents while taking into consideration the revised diagnostic criteria of epilepsy.

Risk of recurrence after a first unprovoked seizure in children

ObjectivesThis study aimed to evaluate the first episode of unprovoked epileptic seizure in children and assess recurrence risk factors. MethodsThis was a retrospective observational study, based on the analysis of medical records of patients admitted between 2003 and 2014, with first epileptic seizure, at the pediatric service of a secondary hospital. The data were analyzed using the SPSS 20.0 program. ResultsOf the 103 patients, 52.4% were boys. The median age at the first seizure was 59 (1‐211) months. About 93% of children were submitted to an electroencephalogram (EEG) at the first episode and 47% underwent neuroimaging assessment. Treatment with an antiepileptic drug was started in 46% of patients. The recurrence rate was 38% and of these, 80% had the second seizure within six months after the first event. Of the assessed risk factors, there was a statistically significant association between seizure during sleep and recurrence (p=0.004), and between remote symptomatic etiology seizure and occurrence of new seizure (p=0.02). The presence of EEG abnormalities was also associated with the occurrence of new seizures (p=0.021). No association was found between age, duration of the seizure, and family history of epilepsy with increased risk of recurrence. ConclusionsMost children with a first unprovoked epileptic seizure had no recurrences. The risk of recurrence was higher in patients with seizure occurring during sleep or remote symptomatic ones and those with abnormal EEG results.

Risk of recurrence after a first unprovoked seizure in children

ObjectivesThis study aimed to evaluate the first episode of unprovoked epileptic seizure in children and assess recurrence risk factors. MethodsThis was a retrospective observational study, based on the analysis of medical records of patients admitted between 2003 and 2014, with first epileptic seizure, at the pediatric service of a secondary hospital. The data were analyzed using the SPSS 20.0 program. ResultsOf the 103 patients, 52.4% were boys. The median age at the first seizure was 59 (1–211) months. About 93% of children were submitted to an electroencephalogram at the first episode and 47% underwent neuroimaging assessment. Treatment with an antiepileptic drug was started in 46% of patients. The recurrence rate was 38% and of these, 80% had the second seizure within six months after the first event. Of the assessed risk factors, there was a statistically significant association between seizure during sleep and recurrence (p=0.004), and between remote symptomatic etiology seizure and occurrence of new seizure (p=0.02). The presence of electroencephalogram abnormalities was also associated with the occurrence of new seizures (p=0.021). No association was found between age, duration of the seizure, and family history of epilepsy with increased risk of recurrence. ConclusionsMost children with a first unprovoked epileptic seizure had no recurrences. The risk of recurrence was higher in patients with seizure occurring during sleep or remote symptomatic ones and those with abnormal electroencephalogram results.

Risk factors for seizure recurrence in children after first unprovoked seizure.

The question of whether to treat a patient after a first unprovoked seizure is controversial. This prospective study assessed the time to recurrence and risk factors for seizure recurrence after a first unprovoked seizure in children. Participants were recruited between 1 July 1997, and 30 June 2009. Eligible candidates were children between 1 month and 15 years old who presented with their first unprovoked afebrile seizure. After enrollment, recurrence of seizures was investigated. All participants were followed for at least 2 years. Log-rank test was used for bivariate analysis to check associations, and hazard ratios were used to analyze variables and clinical outcome (recurrence) during follow-up. Of 73 subjects, 42 (57.5%) experienced recurrence. The overall product-limit estimate of recurrence was 61.9% at 6 months, 85.7% at 1 year, and 95.2% at 2 years after seizure onset, respectively. Incidence of recurrence with partial and generalized seizures was 69.0% and 31.0%, respectively. Children with partial seizures had recurrence significantly more often than those with generalized seizures (P < 0.001). Recurrent seizures occurred after normal findings on electroencephalogram (EEG) in 21.4%, after generalized spike-and-wave complexes in 16.7%, and after focal epileptic discharge in 61.9%. Children with focal epileptic discharge had recurrence significantly more often than children with normal EEG findings (P < 0.001). The time to seizure recurrence after first unprovoked seizure may be within 1 year, and particularly within 6 months; and partial seizure and abnormal EEG with focal epileptic discharge may be risk factors for seizure recurrence.

The incidence of unprovoked seizures and occurrence of neurodevelopmental comorbidities in children at the time of their first epileptic seizure and during the subsequent six months

To evaluate the incidence of unprovoked seizures in children and the prevalence of related neurodevelopmental comorbidities at the time of the presumed first seizure and six months thereafter. The medical records of all children (0-18 years of age) seeking medical attention as the result of a first unprovoked seizure between September 1, 2001 and December 31, 2006, and registered in the population-based Stockholm Incidence Registry of Epilepsy (SIRE) were reviewed. Neurodevelopmental comorbidities were evaluated on the basis of the medical records from this first visit and from other healthcare during the following six months. The incidence of unprovoked seizures was between 30 and 204/100,000 person years (n=766) in the different age groups. It was highest among the youngest children and lowest among the 18-year-olds with small gender differences. The most common neurodevelopment comorbidities were developmental delay (22%, CI: 19-25%), speech/language and learning difficulties (23%, CI: 20-26%) and intellectual disability (16%, CI: 13-18%). The types of neurodevelopmental comorbidity varied by age at the time of seizure onset, with cerebral palsy being more common among the 0-5-year-olds, attention deficits among the 6-16-year-olds, and autism and psychiatric diagnosis among the older children. An associated neurodevelopmental comorbidity was more common among those experiencing recurrent than single seizures during follow-up six months from the index seizure (42% versus 66%). In 68% (CI: 64-71%) of the children there was no known or suspected neurodevelopmental comorbidity. The incidence of unprovoked, non-febrile seizures among 0-18-year-olds included in the SIRE was 67/100,000 person-years. Neurodevelopmental comorbidities were common already at the time of onset of the seizure disorder, indicating that neither seizure treatment nor seizures were the underlying cause of other neurodevelopmental symptoms in these patients during the period studied.

Risk of seizure recurrence after a first unprovoked seizure in childhood

Risk of seizure recurrence after a first unprovoked seizure in childhood